ArticleInternational journal of surgery case reports2026
A lateral decubitus percutaneous vertebroplasty using a facet-joint-transgressing unipedicular trajectory in a hemiplegic patient: a case report with a position-trajectory-gravity coupling strategy.
Article in International journal of surgery case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Percutaneous vertebroplasty (PVP) is typically performed in the prone position using a standard transpedicular approach. However, patients with hemiplegia often cannot tolerate prone positioning due to spasticity and postural instability. Moreover, achieving symmetrical cement distribution through a unilateral approach remains technically challenging. This study introduces a modified technique incorporating a facet-joint-transgressing trajectory combined with a lateral decubitus position to optimize cement dispersion. Case presentation: We report a 70-year-old woman with right-sided hemiplegia following cerebral hemorrhage who presented with an acute L3 osteoporotic vertebral compression fracture. Because of intolerance to prone positioning, PVP was performed in the lateral decubitus position. A novel unilateral puncture strategy via a facet-joint-transgressing trajectory was adopted to achieve a more medialized and anterior needle placement. Cement was injected during the doughy phase, using gravitational forces to facilitate cross-midline diffusion. Postoperative imaging confirmed satisfactory bilateral cement distribution without leakage. The patient experienced immediate pain relief and significant functional improvement. Conclusion: This case demonstrates a novel position-trajectory-gravity coupling strategy, integrating lateral decubitus positioning with a facet-joint-transgressing unilateral approach. This technique enables effective bilateral cement distribution under constrained positioning conditions and expands the technical feasibility of PVP in patients unable to tolerate standard prone positioning.
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